Lumbar–peritoneal shunt

Lumbar–peritoneal (LP) shunt is a medical procedure used to treat hydrocephalus and other conditions where excess cerebrospinal fluid (CSF) accumulates in the brain. This surgical intervention involves the placement of a shunt system to divert CSF from the lumbar subarachnoid space to the peritoneal cavity, where the fluid can be absorbed. This article provides an overview of the LP shunt procedure, its indications, surgical technique, potential complications, and outcomes.

Indications

LP shunts are primarily indicated for the management of hydrocephalus, particularly when other types of shunting, like ventriculoperitoneal shunts, are not feasible or have failed. Conditions such as spina bifida, meningitis, and intracranial hemorrhage can lead to hydrocephalus. LP shunts are also considered in patients with idiopathic intracranial hypertension (IIH) when medical management is insufficient.

Surgical Technique

The LP shunt procedure is performed under general anesthesia. The process involves the insertion of a catheter into the lumbar subarachnoid space, typically between the lumbar vertebrae L2 and L3 or L3 and L4. The catheter is then tunneled subcutaneously to the abdomen, where it is inserted into the peritoneal cavity. A valve mechanism is often included in the shunt system to regulate the flow of CSF and prevent overdrainage.

Complications

As with any surgical procedure, the LP shunt placement can be associated with complications. These may include:

• Infection: Shunt infection is a significant risk, often requiring shunt removal and antibiotic treatment.
• Shunt malfunction: Blockage or failure of the shunt can lead to recurrent symptoms of hydrocephalus.
• Overdrainage: Excessive drainage of CSF can cause headaches, dizziness, and subdural hematomas.
• Abdominal complications: Problems in the peritoneal cavity, such as hernias or peritonitis, can occur.

Outcomes

The success of LP shunt surgery varies depending on the underlying condition, the patient's age, and the presence of comorbidities. Many patients experience significant relief from symptoms of increased intracranial pressure and an improvement in quality of life. However, long-term follow-up is necessary to monitor for complications and assess the need for shunt revision.

See Also

• Hydrocephalus
• Ventriculoperitoneal (VP) shunt
• Cerebrospinal fluid